October is Breast Cancer Awareness Month

by Jane Ashley

October is a time when we honor those with breast cancer, whether they are in active treatment or are survivors or succumbed to their disease years ago. While breast cancer is extremely rare in men, we shouldn’t forget them either – just under 1 percent of all breast cancer occurs in men.

1 Out Of 8

Breast cancer is so much more than “just being cancer” – as if that wasn’t enough – the treatments are often disfiguring and can induce early menopause. Breast cancer puts a lot on our plates, too much for us to digest at one sitting. But with strength and courage and support from our loved ones, breast cancer patients get up each morning and ask, “What next?”

Breast Cancer in 2017/2018 – The Facts

Here’s a snapshot, according to the American Cancer Society, of where we are today.
• 252,710 women diagnosed
• 2,470 men diagnosed
• 63,410 women diagnosed with in situ breast carcinoma
• Deaths – 40,610 women and 460 men
• Over 3,500,000 survivors

Risk Factors

Lifestyle. Just as with most other types of cancer, obesity, inactivity, and alcohol use are associated with breast cancer in post-menopausal women. Two specific risk factors for breast cancer are the prior use of menopausal hormones (combined estrogen and progestin) or not breastfeeding.

Family history. A family history of a first-degree (parent, sibling or child) – if you have one first-degree relative, your risk is 2 times higher and 3-4 times higher if you have more than one first-degree relative. While this sounds ominous, the fact is that most women with first-degree relatives don’t develop breast cancer. But knowing this fact should prompt you to be vigilant about self-exams and annual mammograms.
Personal history of breast cancer. There is a slightly increased risk of developing breast cancer in your other breast. Women who have been diagnosed with DCIS (ductal carcinoma in situ) are about 10 times more likely to develop invasive breast cancer. Women with LCIS (lobular carcinoma in situ) are about 7 o 12 times more likely to develop invasive breast cancer. Once again, your risk is only slightly increased, as scary as this sounds, but it’s just a signal to adopt healthy lifestyle habits and be vigilant.

Eat Healthy

Less common risk factors. These factors are not thought to cause breast cancer but are more common among women who have breast cancer: dense breast tissue, shorter height, early-onset menstrual cycles, menopause after age 54 and higher bone density after menopause. The Susan G. Komen Breast Cancer Foundation provides deep insight regarding breast cancer risk factors.

What are the treatment options?

Every patient’s treatment is determined by the stage of disease and their mutations. Breast cancer is not a one-size-fits-all disease. Treatments are customized to provide maximum results while minimizing debilitating side effects.

Surgery. Surgery is one of two types: 1) a lumpectomy which removes the lump and a small margin of breast tissue surrounding the lump, or 2) a mastectomy that removes the entire breast. A breast reconstruction is sometimes done at the same time as the mastectomy.

Radiation Therapy. Specially trained radiology oncologists use high-energy X-ray beams to kill any cancer cells that may be left after surgery or in lymph nodes near the site of the tumor.

Chemotherapy. Chemotherapy may be used before surgery (neoadjuvant) or after surgery (adjuvant). Chemotherapy is used before surgery to shrink a large tumor in the hope that the patient might be able to have a lumpectomy. Chemo is also used before surgery to help shrink a locally advanced tumor and/or adjacent lymph nodes so that it’s easier to surgically remove. Adjuvant chemotherapy, sometimes called “mop-up” chemo, is used after surgery to help kill any remaining cancer cells.

Hormone Therapy. Most breast cancers need either estrogen and/or progesterone to grow. The pathology report shows whether the cancer is hormone receptor-positive-or-negative. Unfortunately, most tumors are hormone receptor-positive. Patients take hormone therapy for at least five years to help prevent recurrence.

Targeted Therapy. Targeted therapy works on breast cancer cells that have certain markers. The best-known example is the HER2 protein that is found on some breast cancer cells. Herceptin kills those cells while not harming healthy cells. For most patients, targeted therapy doesn’t cause the side effects that chemotherapy causes.

Metastatic breast cancer

Sadly, over 150,000 women are living with metastatic breast cancer. Breast cancer most commonly will spread to the bones, brain, liver or lungs. Even though it’s in a different organ or in a patient’s bones, it is considered breast cancer that has spread (metastasized) to a distant organ. And it’s treated like breast cancer.

Metastatic Breast Cancer

Patients are living longer and with better quality of life. About one-third of all women with metastatic breast cancer in the U.S. have had their metastatic cancer for over five years. Newer treatments like Ibrance, Kisqali, and Verzenio are allowing many metastatic breast cancer patients the option to postpone chemotherapy, some for up to two years.

Survivorship in 2018 So What Next?

Researchers are gaining new knowledge about breast cancer at an astonishing rate. More patients are surviving and thriving. But every breast cancer survivor still faces challenges including bone loss, early onset menopause, loss of fertility, their sexuality and self-image. Survivors worry about their relatives who have an increased risk for breast cancer and most especially, for their daughters. Fear of recurrence rests heavy on survivors’ minds too.

Maybe you’re over Pinktober . First lady Betty Ford’s disclosure of her breast cancer diagnosis in 1974 undoubtedly sparked other women talk about their diagnosis. And women wearing pink in those early years drew attention to breast cancer. That increased awareness brought needed research dollars for new and more effective treatments. That awareness took away the embarrassment that many patients felt about disclosing what type of cancer they had. That awareness found corporate sponsors for free mammograms. That awareness has helped women take control of treatment choices, including whether to have reconstruction surgery or “live life flat.” Breast cancer awareness has brought screening levels up so that breast cancer is detected earlier when it can be cured.

So what’s next? More knowledge, better treatments, fewer side effects … more time for more patients to live fulfilling lives without constant fear and anxiety.
 

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